Following the passage of a Republican bill to repeal President Obama's health care law in the House last week, the Senate is about to consider a similar bill. Some critics of repeal are reminding voters that a health care reform measure has been in effect in Massachusetts for four years. So it's fair to ask: Has health care reform worked in the Bay State?

Not surprisingly, the answer depends on whom you ask. Stuart Altman, professor of national heath policy at the Heller School for Social Policy at Brandeis University, says the Massachusetts Health Reform Plan has worked on a number of levels but mainly in extending coverage to the uninsured. The percentage of the state's uninsured went from 7% to 2.5%, he says, but has since returned to around 3% because of the economic crisis."Massachusetts has by far the lowest uninsured rate in the country," Altman notes. But he warns that the Massachusetts experience cannot necessarily be taken as an example of how well Obamacare might work because of regional differences within the country.

Not an Overwhelming Success

Michael Cannon, director of health policy studies at the libertarian CATO Institute, says the Massachusetts law hasn't been an overwhelming success. "Everyone is spending someone else's money and can't believe they are spending their own," Cannon says. "We still have doctors and patients spending the government's money, and you've still got workers spending their employers' money."

Cannon says while it's generally acknowledged that insurance enrollment went up in Massachusetts under the health reform law, he reckons the numbers are inflated by a large percentage because people are afraid to admit they don't have insurance because of possible penalties.

The Massachusetts health plan, which was adopted in 2006 under the administration of Republican Governor Mitt Romney, includes an individual mandate -- which means you can lose your tax deduction if you don't have insurance; a requirement that employers provide health insurance or pay the state; and subsidies for low-income families.

Supporters of the law say it was designed only to increase coverage, not bring down costs, which opponents dispute.

An academic study by John F. Cogan and Daniel Kessler of Stanford University and Glenn Hubbard of Columbia University estimated that the Massachusetts plan has caused heath insurance premiums to rise 5.9% more than in the rest of the U.S. for the period from 2006 to 2008.

Brandeis' Altman counters that Massachusetts has had higher health care costs than the rest of the country for more than a decade, and as a result, the higher costs now "have nothing to do with reform."

Primarily, he says, they reflect Massachusetts' use of more expensive teaching hospitals to do jobs usually handled by community hospitals in other states.

Reform Spurs Innovation

Altman maintains that the reform has "forced Massachusetts to really deal with its cost problem and do things that a lot of states haven't even begun to think about." Among the innovations: Blue Cross Blue Shield has adopted a new payment model designed to reward doctors and hospitals for the quality of the care they provide and not just the quantity.

"Our new approach to payment was designed to address the twin goals of improving the quality and outcomes of patient care while significantly cutting the rate of growth in health care spending," says Andrew Dreyfus, CEO of Blue Cross Blue Shield of Massachusetts. "We are making significant progress toward both goals."

While some critics have complained that the state-funded Medicaid rolls have swollen under the reform effort, others point out that they've grown in most states because of the economic crisis, a time when many workers lost jobs along with their employer-provided health insurance.

The Massachusetts example is unlikely to resolve the debate in Washington, unless Romney enters the presidential race again in 2012 and is forced to defend his actions before a largely hostile, Tea Party-dominated Republican party. But a straw poll in New Hampshire last week showed that Romney is still the leading candidate on the GOP side, despite the party's strident opposition to health care reforms.

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Jack

The only one way to save on your health insurance is to use insurance comparison sites.If you try to search google you will find only big promises, but nothing more ...I didn't believe it, but I tried and I saved more than 30%.That is possible because once people register, they receive free quotes from many insurance companies, so they are able to compare and to save money.

My husband works for a large company. Our healthcare, Cigna is $500.00 a month,with a $1500.00 deductible. Its outrageous and too expensive, and still everything is NOT covered. We need to fix the healthcare mess in this country. We need the public option....

The Republican party is bipolar.. They twist facts to suit their own political agenda, and outright lie about most everything... That lying is called demagoguery... and it is especially rampant amongst all conservatives.. As a moderate who eschews the far right or left, I am appalleld by their lack of intelligence, and civility on every subject.. They are NOT taking "their" country back,because I have news for the far right.. It is "our" country too, and they will have to fight for it.

I am sick and tired of being kicked around by the right, called a Marxist, or unpatriotic, when I am far from being a Marxist and love my country as much as they do. My strongest desire is for them to wake up , shut up and cooperate, and assuming they are mentally incapable of doing that, move to Texas, where they set up an armed concentration camp around the entire Texas border, and every man woman and child carries arms to assure their border's integrity. In other words, TEA PARTY..... GO straight to hell.

I TOTALLY agree it's true.., That the Obama administration gave this BILL the wrong name...It shouldn't be called "Healthcare Reform" it (should) be called "HEALTH INSURANCE REFORM"... The opposition would have harder time nationally defending that lobby...

I TOTALLY agree it's true.., That the Obama administration gave this BILL the wrong name...It shouldn't be called "Healthcare Reform" it (should) be called "HEALTH INSURANCE REFORM"... The opposition would have harder time nationally defending that lobby...

It's hysterical reading the reply to this story. People do not even understand how healthcare worsk - how costs (procedures, visits, etc) are negotiated and how unisnured rates are NON-negotiated charges - how they have been paying for the uninsured with EXTREMELY higher rates for DECADES. You see, there is this silly little law that says a physician/hospital/clinic MUST MUST MUST provide care. It's their "right" (how I missed that in Constitutional Law is beyond, but I digress). Folks - who do you think pays the bill for all these people that either too uninsurable, too poor, too lazy, or too greedy (yes - greedy!) to purchase insurance? Who do you think pays the bill for those that don't have insurance and default on the bill? The hospital/clinic/doctor has to get paid. Now, let's stop for a minute. Inhale. Exhale. And then think. It's funny that those that REFUSE to get insurance are the ones that scream the loudest. Simple solution: Take out a $20 a month policy with a $10,000 deductible. Yes, they are out there and it will satisfy the law.

The health care system does not work in Massachusetts!! We lost our home due to the costs of having to pay for health insurance! I knew when this first went into effect that we would not be able to pay the mortgage and the high costs of the health insurance. Sure enough after the first year we were getting behind. Glad to be out of the state! The only people that can afford to live there are the rich and people on welfare!

They asked the CATO institute? They march in perfect goose step of whatever the Republican Party is saying. They are the last people to ask an unbiased opionion on anything. Sounds like it is working, and the only ones not insured are illegal aliens. So much for the sky is falling. I suppose we can just go back to the Republican plan, if you get sick and are not insured, die quickly. Of course unless it supports the rich, the GOP has no interest in it. They long ago abandoned the poor and middle class.

wilbgone ;The rich are the ones outsourcing jobs to over seas and taking tax breaks and stimulus money to do so ,all CEO's have a contract with their companies and i bet you that their healthcare is covered ,any fool that does not have a contract with their company deserve what they get ....Why should a billion dollar company like walmart and others be able to dump their employees healthcare on medicare to add to their billion dollar bottom line ,walmart is the number user of medicare,medicaid in 26 states ,if I don't like shopping at walmart why should my tax money add the their billions like so many other companies,you refer to the VA they have a (public option) that all the repubs voted for a few years ago ,so everbody else does not deserve what the VA gets,all other countries have Universal healthcare and the US is where the insurance companies make billion in profits

The MEGA rich, sure, I agree but what I am talking about are the small to mid-size companies. The huge stores like Wal-Mart do offer insurance but they do not cover ALL of the costs and expect the employees to pay a percentage. They also pay so little that most cannot afford it so they go on Medicaid instead. It is a game to them. The company I work for has 50 employees. They cover about 70-80% of the insurance for the workers but still some have Medicaid instead. Why? Because group coverage is more expensive for one. The average is about $1,100/month for a family which most workers have. Multiply that by 50 and you have about $50,000.00/month that the company would have to absorb just to get coverage whether or not it is used. The insurance companies are the profit makers here, no doubt but I don't think it is possible to fix the problem because we as Americans have come to expect certain things and that will drastically change if we get "Socialized" medicine. Try waiting for 16-18 months before you are "allowed" to have an elective surgical procedure. THAT is what you get in Canada and Europe. Americans won't do it. So, what are the alternatives?

I do not see where anyone talks about the UNIVERSAL HEALTHCARE in Hawwaii for the past forty years ,the teabaggers were there for a rally to protest UNIVERSAL HEALTHCARE and they did not check that it has been working there forty years ,When they ask some of them about it all they could say was they hoped it failed.....